All Policies Are Health Policies

For every future project the District of Columbia undertakes, it will ask the same question: How does this impact the public’s health?

Washington, D.C., Mayor Vincent Gray in 2011 set forth an audacious goal for the nation’s capital: “In just one generation—20 years—the District of Columbia will be the healthiest, greenest and most livable city in the United States.”

The plan, known as Sustainable DC, calls for the city to improve health and wellness, grow jobs and the economy, ensure equity and diversity, and protect the environment. In all, there are nearly one dozen initiatives. But what makes the plan, well, audacious, is that health takes center stage in every one of the initiatives.

Driving this goal is a concept known as Health in All Policies (HiAP), which has been gaining momentum throughout the nation. The idea is that all policy is health policy; HiAP advocates recommend scrutinizing any proposed program, project or policy before it is ever implemented for its potential effect on the health and well-being of citizens. Washington, D.C., has created a HiAP task force that will set recommendations to ensure health equity is integral to the sustainability plan.

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But setting a health-based threshold for such a broad array of community initiatives isn’t easy. To that end, the district’s health department is working with the National Association of County and City Health Officials (NACCHO), which comprises 2,700 local health departments across the United States, to promote health and equity, including awareness about HiAP. The association’s HiAP outreach efforts started last May with a series of two-day leadership academies, which were funded by the Centers for Disease Control and Prevention and included the local health departments from the district, Fairfax County, Va.; Montgomery County, Md.; and the city of Baltimore. Other jurisdictions involved with HiAP strategies include California and King County, Wash.

Ken Smith, NACCHO’s lead program analyst for chronic disease and environmental health, says the academies are an extension of general training they do with other city and county health departments, but are expanded for HiAP training to include cross-sector teams. “We had people from planning, housing; one brought someone from their board of supervisors,” he says. “We wanted people from different perspectives, not just within the health sector.”

The first component of the curriculum was getting everyone to understand that many of the problems within health are determined by the environment, and the decisions that shape the environment are outside the health sector, according to Smith. The goal is to have “everyone on the same page about the role of other departments in shaping health,” he says. “We then cover strategies for integrating the different agencies to address these complex problems.”

The D.C. trainees talked about their specific barriers, including competing priorities, systems that don’t talk to each other and categorical funding. The district also has some unique benefits, including a number of “in-house experts” that other jurisdictions may lack.

It’s now up to the district’s HiAP task force to develop a plan, and NACCHO will be there to help. Smith and his team check in regularly to troubleshoot and share stories of what’s working in other areas, and “they have access to all our resources and can request any kind of assistance.”

A long-term goal of the leadership academies is to cultivate regional leaders. “A lot of issues of environmental health are regional in nature,” Smith says. For example, “with D.C. taking a leadership role in air quality, they can help facilitate a more regional way of addressing this problem.”

Smith calls Sustainable DC a perfect example of the HiAP approach because it establishes the planning that ensures different agencies talk to each other. “Our position is that local health departments, working in collaboration with other agencies, should take the leadership role in implementing health and wellness policies,” he says. “Let city and county governments take the lead. They are at the right level to move health forward as a major policy consideration where people live, work and play.”